RN Case Manager - ACO - Remote

Optum-posted about 1 year ago
$58,302 - $114,296/Yr
Full-time • Mid Level
Remote • Los Angeles, CA
5,001-10,000 employees
Insurance Carriers and Related Activities
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The RN Case Manager position at Optum involves providing professional nursing care to patients, focusing on care coordination and management within an integrated health care system. The role emphasizes health equity, quality, and convenience, aiming to improve patient outcomes through effective communication and collaboration with healthcare teams. This remote position allows for flexibility while addressing the needs of high-risk patients across various care settings.

  • Prioritizes patient care needs upon initial visit and addresses emerging issues.
  • Meets telephonically with patients, patients' families, and caregivers as needed to discuss care and treatment plan.
  • Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings.
  • Consults with the physician and other team members to ensure that the care plan is successfully implemented.
  • Uses protocols and pathways in line with established disease management and care management programs to optimize clinical outcomes and minimize unnecessary institutional care.
  • Monitors and coaches patients using motivational interviewing techniques and behavioral change to maximize self-management.
  • Oversees provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of care.
  • Works in coordination with the care team and demonstrates accountability with patient management and outcome.
  • Discusses Durable Power of Attorney (DPOA) and advanced directive status with patient and PCP when applicable.
  • Maintains effective communication with the physicians, hospitalists, extended care facilities, patients and families.
  • Provides accurate information to patients and families regarding resources available to them through health plan benefits, community resources, and referrals.
  • Participates actively in Monthly Care Management Department meetings and daily huddles.
  • Documents pertinent patient information and Care Management Plan in Electronic Health Record.
  • Coordinates care with central departments on assigned patient caseload, including inpatient, long-term care facilities, adult family homes, and home health agencies.
  • Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization reports and systems such as Health Plan Benefits, CM dashboards and reports.
  • Maintains concise and accurate documentation that supports effective and efficient management of care plans to decrease Emergency and hospital readmissions.
  • Adheres to departmental policies and procedures. Uses, protects, and discloses HCP patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
  • Participates in training all new care managers.
  • Graduation from an accredited school of nursing.
  • Active, unrestricted Registered Nurse license through the State of California.
  • 1+ years of experience in a clinical setting or care management.
  • Bachelor of Science in Nursing, BSN.
  • 3+ years of experience working in acute care.
  • 1+ year(s) Previous care management, or discharge planning experience.
  • ACO experience.
  • Ambulatory experience.
  • HOM & PPO Experience.
  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
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